Driver Application

Become a Driver

Step 1 of 9

Thank you for your interest in applying with KT Logistics, LLC; below is the application for all driving positions that need to be completed in its entirely. Please provide ten (10) years of employment history, including all periods of unemployment from the date of application (example: applying in June 2020; need employment/unemployment history back to June 2020). Time periods not accounted for will delay approval of your application. Thank you and please have a “safe” and wonderful day.
Application for Employment
Today's Date*
MM slash DD slash YYYY
Name of Driver*
First Last
Phone Number*
Social Security Number*
Date of Birth*
Position Applying for*
Date Available*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
How long at current address?*
Previous Address 1
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Previous Address 2
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Previous Address 3
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Driving Records
Driver license information (include current and past licenses for the last 3 years)
State*
License Number*
Class/Endorsements*
Expiration Date*
MM slash DD slash YYYY
Any Other Licenses?*
- Yes
- No
State*
License Number*
Class/Endorsements*
Expiration Date*
MM slash DD slash YYYY
Driving Experience
Do You Have Prior Driving Experience?*
- Yes
- No
Type of Equipment*
Period of Time*
Nature and Extent*
Have More Experience?*
- Yes
- No
Type of Equipment*
Period of Time*
Nature and Extent*
How many accidents have you had within the last 5 years?*
Date of Accident
Location
Nature of Accident
Fatalities/Injuries
Ruling
Date of Accident
Location
Nature of Accident
Fatalities/Injuries
Ruling
All other Violations
Traffic Violations
List all motor vehicle laws or ordinances or which you were convicted or forfeited bond or collateral during the last 3 years preceding of this application.
Have you had any traffic violations in the last 3 years?*
Violation 1
Violation 2
Violation 3
Revocations & Suspensions
Have you had a license, permit, or privilege to operate a motor vehicle denied, revoked, or suspended ever?*
- Yes
- No
How many Times?
Incident 1 Details
Incident 2 Details
All other Incident Details

Education
Highest Level of Education*
School Name & Location*
Course of Study
Grade Point Average
Employment Experience
Employer Name
Employer's Phone
Supervisor
Date Employed From
MM slash DD slash YYYY
Date Employed To
MM slash DD slash YYYY
Employer's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Job Title
Hourly Rate/Salary

Starting and Final rates
Reason For Leaving
Work Performed
Were you subject to the FMCSRs while employed by this employer?
- Yes
- No
Was the job designated as a safety sensitive function in any regulated mode subject to alcohol and controlled substance testing as required by 49 CFR Part 40?
- Yes
- No
Special Skills and Qualifications
Summarize special job-related skills and qualifications acquired from employment, schooling, and other experience not listed elsewhere on this application.

Agreement
“I, the applicant certify that the application was completed by me, and that all entries on it and information contained in it are true and complete to the best of my knowledge. I understand that if I am employed, false statements may result in my immediate dismissal. I authorize the motor carrier to make an investigation of any of the facts set forth in this application.”

All offers of employment are conditional upon satisfactory reference checks, evidence, or completion of a DOT medical exam and receipt of a negative pre-employment drug screen.
Today's Date*
MM slash DD slash YYYY
Applicant Signature*

EMPLOYEE AUTHORIZATION AND COMPANY REQUEST FOR INFORMATION FROM PREVIOUS EMPLOYER
I hereby authorize you to provide the motor carrier with the following information regarding my past employment work history, alcohol and controlled substance testing results, services, character and conduct while in your employ. You are released from any and all liability that may result from furnishing such information. A photocopy of this authorization is to be considered valid as the original.
Today's Date*
MM slash DD slash YYYY
Applicant Signature*
The above individual has applied with the motor carrier in a safety-sensitive position as a tractor/trailer CMV operator. In accordance with the FMCSR 391.23, 382.413 and 382.405, we are providing you will the driver’s written authorization for the purpose of obtaining verification of the individual’s safety performance history and drug & alcohol testing results.

FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT
In accordance with the provisions of Section 604(b)(2)(A) of the Fair Credit Reporting Act, Public Law 91- 508, as amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter I, of Public Law 104-208), you are being informed that reports verifying your previous employment, previous drug and alcohol tests results, applicable school records, and your driving record may be obtained on you for employment purposes. These reports are required by sections 382.413, 391.23 and 391.25 of the Federal Motor Carrier Safety Regulations.
Today's Date*
MM slash DD slash YYYY
Applicant Signature*

MOTOR VEHICLE DRIVER’S CERTIFICATION OF VIOLATIONS
I certify that the following is a true and complete list of all traffic violations (other than parking violations) for which I have been convicted or forfeited bond or collateral during the past twelve (12 months).
Please Explain Offenses:
Today's Date*
MM slash DD slash YYYY
Applicant Signature*

DOT D/A Disclosure and Authorization
PART I – DISCLOSURE AND AUTHORIZATION FOR RELEASE OF INFORMATION FOR EMPLOYMENT PURPOSES – 49 CFR PART 391.23, DOT DRUG AND ALCOHOL TESTING

In accordance with DOT Regulation 49 CFR Part 391.23, I hereby authorize release of my DOT-regulated drug and alcohol testing records by the DOT-regulated employer(s) listed below to HireRight for the purpose of HireRight transmitting such records to the HireRight customer listed above. I understand that information/documents released pursuant to this Part I is limited to the following DOT-regulated testing items, including pre-employment testing results, occurring during the previous three (3) years: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested (including adulterated and/ or substituted tests); (iv) other violations of DOT drug and alcohol testing regulations (i.e., violations of 49 CFR 382 Subpart B); (v) information obtained from previous employers of a drug and alcohol rule violation; and (vi) any documentation of completion of the return-to-duty process following a rule violation.

If any company listed below furnishes HireRight with information concerning items (i) through ( vi) above, I also authorize such company to furnish the following information to HireRight, if applicable: (i) dates of my negative drug and/or alcohol tests and/or tests with results below 0.04 during the previous three (3) years; and (ii) the name and phone number of any substance abuse professional who evaluated me during the previous three (3) years.
Previous DOT-Regulated Employer(s)*
List all DOT-regulated employers you have applied with and/ or worked for in a safety-sensitive function during the previous three (3) years.
By signing below, I certify that: (i) all information provided herein is complete and accurate; (ii) I have read and fully understand this Part I disclosure and authorization for release as well as the attached FMCSA Notification of Driver Rights and any applicable state law notices; (i ii) prior to signing I was given an opportunity to ask questions and to have those questions answered to my satisfaction; ( iv) I execute this authorization voluntarily and with the knowledge that the information obtained pursuant to this authorization could affect my eligibility for employment, promotion, retention or other lawful purpose; ( v) I understand I may review this document with legal counsel prior to signing; and (vi) facsimile or photographic copies of this authorization are as valid as an original.
Today's Date*
MM slash DD slash YYYY
Applicant Signature*

FMCSA Notification of Driver Rights
In compliance with 49 CFR Part 40 §391.23 you have certain rights regarding the safety performance history information that will be provided to prospective employers. I) You have the right to review information provided by previous employers. II) You have the right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to prospective employers. III) You have the right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information. (2) Drivers who have previous DOT regulated employment history in the preceding three years and wish to review previous employer-provided investigative information must submit a written request to prospective employers. This may be done at any time, including when applying, or as late as 30 days after being employed or being notified of denial of employment. Prospective employers must provide this information within five business days of receiving the written request. If prospective employers have not yet received the requested information from the previous employer, then the five day deadline will begin when the requested safety performance history information is received. If you have not arranged to pick up or receive the requested records within 30 days of prospective employers making them available, the prospective employers may consider you to have waived your request to review the record.
IMPORTANT DISCLOSURE REGARDING BACKROUND REPORTS FROM THE PSP ONLINE SERVICE In connection with your application with DRT Transportation/KT Logistics (“Prospective Employer”), Prospective Employer, its employees, agents, or contractors may obtain one or more reports regarding your driving and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA). When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking and final adverse action. If any final action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report. When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer used any information it obtains from FMCSA in a decision to not hire you or make any other adverse employment decision regarding you; the Prospective Employer must provide you within three business days of taking adverse action oral, written, or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA; that he FMCSA did not make the decision to take adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a copy of you driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act. Neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. You may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. Your request will be forwarded by the DataQ system to the appropriate State for adjudication. Any crash or inspection in which you were involved with displace on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspection, with or without violations, appear on the PSP report. State citations associated with Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report. The Prospective Employer cannot obtain background reports from FMCSA without your authorization. If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: I authorize DRT Transportation/KT Logistics (“Prospective Employer”) to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am authorizing the release of safety performance information, including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee. I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https;//dataqs.fmcsa.dot.gov. If I challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication. I understand that any crash or inspection in which I was involved will display on my PSP report. Since the PSP report does not report, or assign, or imply fault, I acknowledge it will include all CMV crashes where I was a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appears on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on my PSP report. I have read the above Disclosure Regarding Background Reports provide to me by Prospective Employer and I understand that if I sign this Disclosure and Authorization, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.
Today's Date*
MM slash DD slash YYYY
Applicant Signature*

Driver Application

Become a Driver

Driver Application

Step 1 of 9

Application for Employment

Driving Records

Driving Experience

Traffic Violations

Revocations & Suspensions

Education

Employment Experience

Special Skills and Qualifications

Agreement

EMPLOYEE AUTHORIZATION AND COMPANY REQUEST FOR INFORMATION FROM PREVIOUS EMPLOYER

FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT

MOTOR VEHICLE DRIVER’S CERTIFICATION OF VIOLATIONS

DOT D/A Disclosure and Authorization

FMCSA Notification of Driver Rights

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